Provider Demographics
NPI:1639407828
Name:PETER AGHO, MD, PC
Entity Type:Organization
Organization Name:PETER AGHO, MD, PC
Other - Org Name:AGHO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-245-0200
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-0491
Mailing Address - Country:US
Mailing Address - Phone:212-245-0200
Mailing Address - Fax:
Practice Address - Street 1:1531 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6127
Practice Address - Country:US
Practice Address - Phone:718-597-3111
Practice Address - Fax:718-597-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-26
Last Update Date:2009-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190503261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466059Medicaid
NYF51758Medicare UPIN
NY01466059Medicaid